June 25, 2002 -- Intergenerational day care programs, an innovative service that combines young children and older people in the same care facilities, have proliferated through the U.S. in the last decade. Goals of such programs have been to enhance the children's learning, prevent substance abuse, transform ageist attitudes, provide mentoring, decrease isolation and build generational interdependence.

However, new research reveals that, compared to regular adult day care centers, these programs are at greater risk for infantilizing the elderly clients they serve. (Infantilization is the societal treatment of old age as a second childhood, with little or no recognition of a lifetime of experiences that separate aged persons from children.)

As part of her ongoing research into environments and behaviors in aging services, University of Utah Department of Family and Consumer Studies Assistant Professor Sonia Salari spent several years observing adult day care facilities in the northeast and western parts of the United States. From1999-2001, Salari focused her studies on non-residential, intergenerational day care programs where childcare services were offered in the same building with about 40 adult clients.

Salari and her research team observed more than 220 hours in adult day care centers and spent more than 100 of those hours in centers that combine generations observing the interactions between adult clients, the staff and the pre-school aged children. Many elderly participants were interviewed to provide an insider's perspective.

Salari, who strongly supports the concept of the intergenerational day care format, observed four programs that varied widely in their treatment of the elderly. Evaluation examined quality-of-life issues, which took into account meaningful activities, dignity, privacy, individuality, autonomy, choice, environmental factors and personal relationships. These issues, according to Salari, remain imperative as older persons lose cognitive and physical functioning. "Some adult day services gear activities to the lowest cognitive functioning person. Many clients are mentally aware, but not physically capable of being left alone at home. So this patronizing treatment is especially offensive," she says.

Salari studied one exemplary intergenerational program where, without exception, the format provided older clients choices in music, friends, and activities - even an escape option for those who did not want to participate. The adults were the children's mentors and their privacy was respected. The setting was similar to a country club and clients had some unscheduled time to facilitate interaction and to form friendships.

The model program's high marks were also attributed to an especially gifted visiting facilitator who took genuine interest in the clients and conversed with them on an adult level. She learned their histories and acknowledged their adult accomplishments. "She was so approachable that the clients would actually seek her out," Salari says. "For some caregivers it's an inborn talent, but all adult day care center staff can be encouraged to adopt these philosophies," Salari says.

Conversely, another intergenerational day care program treated the adults as status equals with the children with staff using baby talk and nicknames. Child-oriented stories and games were aimed at both children and adults. This program forced clients to always remain awake and required participation in central, mandatory activities. Elderly persons were addressed in language usually reserved for very young children, including reprimands such as "BEHAVE!" and "Do you need to go to time out?" Privacy violations included announcements such as "We are going to the potty." Salari documented what she terms "anticipatory withdrawal" by two women who plotted ahead of time not to participate in the intergenerational activities. The environment in the room designated for seniors was also age inappropriate as large-scale, child-oriented decorations hung on the walls. Clients interviewed perceived that they had no choice in activities. They enjoyed the children, but sometimes felt overly stimulated by the frequent child visits, and they resented being treated like children.

Salari's work may impact future public policies and care centers' procedures. However, she says the most important aspect of her research is to raise the awareness of the treatment of older people-by care facilities and by their family and friends.

"Sometimes adult children unintentionally infantilize their own parents when they describe a type of role reversal. They might say, 'My parent is now my child.' Instead, and more appropriately, they should say, 'I'm now my parent's caregiver.' That allows parents to retain their adult status and may even remove some of the burden perceived by the adult child," Salari says.

Services for those with dementia should provide adult status. "We aren't sure how much those with low cognitive functioning can perceive. There is evidence they may be able to recognize indignities. It's never OK to infantilize an adult," emphasizes Salari.

Gerontologists like to think of aging services as consumer-driven, Salari says. Today, these consumers are no longer called "inmates," as they were in facilities of the past. However, she predicts that aging baby boomers will demand improved conditions and more dignified treatment. Aging services need to be prepared to meet that demand.

The study, titled "Intergenerational Partnerships in Adult Day Centers: Importance of Age-Appropriate Environments and Behaviors," appears in this month's issue of The Gerontologist.